The Sunday Gentleman (25 page)

The psychiatrist knew what was wrong with Larry, and how his psychosis was being evidenced, but was extremely doubtful whether analysis could lead him back toward normality. It was one afternoon, in the latter stages of treatment, that the psychiatrist mentioned a new operation known as prefrontal lobotomy. Had Larry ever heard of it? He had not.

But soon, reading voraciously, Larry knew a great deal about it. He learned that, before 1935, medical men understood little of the function of the frontal lobes in the human brain, though they realized that whenever these lobes were damaged or removed in tumor operations, the mental makeup of the patient changed. A celebrated case, concerning a middle-aged member of the New York Stock Exchange, had been reported on by Dr. Richard M. Brickner, a New York neuropsychiatrist. In this case, while removing the patient’s brain tumor, both frontal lobes, a quarter of a pound of tissue, had been cut away. Recovering, the patient underwent a complete personality change. Though his intelligence was unimpaired, he lost his ability to reason as logically as before, lost his feelings of self-consciousness, became an abnormal braggart and became indifferent to his earlier illness and to worries in general.

Meanwhile, in 1935, a group of Yale research scientists, headed by Dr. Carlyle F. Jacobsen and Dr. John F. Fulton, had given a chimpanzee a series of tests, before and after removing its frontal lobes, with significant results. According to one medical report of this experiment, “Before operation, if the animal made a few mistakes, he would scream with rage, urinate and defecate in the cage, roll in the feces, shake the bars and refuse to continue the experiments. After the operation, the same animal would continue in the experimental situation long beyond the patience of the examiner, making mistake after mistake, without the least indication of being upset emotionally.”

In 1936, a distinguished Portuguese neurologist, sixty-one-year-old Dr. Egas Moniz, appeared in Paris to report to the Academy of Medicine that he had devised an operation to help psychotic patients, an operation called prefrontal leucotomy or lobotomy. Dr. Moniz, a professor at Lisbon University, the author of three hundred medical papers, and onetime Foreign Minister of Portugal, working with an associate, Almeida Lima, had bored buttonlike holes in the foreheads of his patients, inserted a slender, needle-thin scalpel, and cut through brain tissue and nerve fibers connecting the frontal lobes with other parts of the brain. He had found this technique fairly successful in paranoia or persecution mania cases and in schizophrenia or split personality cases. He had found that while the operation seemed to cut away the patient’s ability to imagine and anticipate, it also cut away his cares and anxieties. In 1936, Dr. Walter Freeman and Dr. James W. Watts, of George Washington University, Washington, D.C., began performing Dr. Moniz’s prefrontal lobotomy in the United States, and by the end of the year had performed twenty such operations. On learning that Drs. Freeman and Watts were the foremost lobotomy specialists in the United States, Larry tried to read all he could about them and their cases. In the Albuquerque library, he located an issue of
Time
magazine, published late the year before, that had the most recent report on the team of psychosurgeons. “Of their 136 cases,” he read, “Drs. Freeman and Watts regarded 98 as greatly improved, 23 as somewhat improved, 12 as failures. Only 13 patients are still in mental hospitals; most are back to their jobs or housekeeping after one to six years of psychotic incapacity.”

When he finished his reading, Larry’s decision was made. He could not go on as he was, any longer. His mind had become his enemy. It told him that he had no right to relax, to enjoy himself, to live. It entombed him in fear, fear of the next day, of the world around him, of himself. He would cut himself free of this mind. He would go East, at once, and have a prefrontal lobotomy.

Accompanied by Harriet, he went to New Jersey and lived with one of his brothers, who was eager to be of help. Together they consulted two psychiatrists, one in Philadelphia and one in New York City, about the wisdom of a prefrontal lobotomy operation. Both psychiatrists firmly advised against it as “too drastic at this time.” Larry was confused. He had been afraid to live, afraid to die, and the lobotomy had presented itself as a lifebelt, with which to survive as long as fate decreed. Now the lifebelt was being withheld from him and there seemed no other choice. Then, suddenly, overnight, there were a half-dozen choices, and Larry, snatching at anything and everything, began his Dantesque journey through Hell.

While Harriet remained with his brother in New Jersey, Larry entered the special mental clinic of a major New York hospital, in January, 1944. He lived inside the walls of the hospital for one unrelieved year, without once venturing outdoors. He was assigned a woman psychiatrist. It was felt that the change in the sex of his analyst might be beneficial. But after several months, the woman psychiatrist pronounced him beyond the help of psychoanalysis. She, after calling in other doctors for consultation, decided upon insulin and electric shock treatments. The doctors administered sixty shock treatments to Larry. The hospital claimed that they had never before given a patient so many. Before going downstairs for each shock treatment, Larry would stiffen with fright. Yet, after it was over, he never remembered having had it. As time passed, the hospital became Larry’s entire outer world. He occupied himself with reading, Ping-pong, oil painting. He did some handicraft work. And he sank deeper and deeper into his manic-depressive anxiety state. At year’s end, the hospital admitted that no similar case had been confined so long. At year’s end, there was no real improvement in Larry, despite his momentary periods of high elation. He finally left the clinic and rejoined Harriet in New Jersey.

Now, acting on every new suggestion made, Larry began riding a mad merry-go-round of therapy. There was the German refugee psychologist-religionist, a Jew possessing a library of perhaps six thousand books and pamphlets on Jesus, who tried to infuse him with faith in the future and in God. There was a new psychiatrist in Kentucky. And a kindly, perceptive young analyst in East Orange, New Jersey, whose medical summary of Larry read, “He was in an extremely agitated state. He paced about the room, wept, distorted his face grotesquely and complained bitterly about obsessive thoughts. Everything was ‘a torture to me—your shoelaces, your tie, that dresser scarf—the very thought torments me.’ It was felt that he was possibly suicidal, although his anxiety was by far the predominant feature of his mental picture. After four months, we began to change our diagnosis. We felt that the illness was considerably more malignant than a diagnosis of anxiety state would indicate. His illness came to be thought of as Pseudoneurotic Schizophrenia.”

Finally, there was even a miracle man in New England, who worked wonders by inserting strange tubes and rubbing secret compounds. After Larry visited the miracle man, he enjoyed a relatively good period. He even felt, briefly, that the miracle man might save him. But, in the end, it turned out to have been only his manic stage, and when his depressive stage arrived again, with its private hell of crying spells and perspiration baths and twisting abdominal pains, and he threatened suicide, the miracle man was quickly abandoned, as had been all the rest before him.

Larry’s limited social life was equally frustrating. Once, double-dating with an old acquaintance in New York, Larry, in a deep downbeat mood, discussed the ethics and pleasures of suicide. This not only threw a wet blanket on the evening, but infuriated Larry’s friend, until he finally told Larry that he was a fake. If he wanted to commit suicide, why didn’t he? He was just playing on everybody’s sympathy, trying to get attention.

“Harriet later told me how Larry argued back,” Jack says. “The friend just didn’t understand. Most people didn’t. They could look at a man who’d lost an arm or a leg and realize his incapacity. But they couldn’t understand a mental cripple. They couldn’t grasp that, like a man who’s lost a limb, Larry had lost something in his head. They’d see he looked healthy, and that he was smart, and they’d say all he needed was to snap out of it. It was like telling a man without legs to get up and walk. After that, there were no double dates.”

It was late in 1945. Since abandoning the miracle healer, they had run out of doctors, and Harriet suggested that another change of scenery might do him good. From that moment, they were constantly on the move. They went to Tucson, Arizona, to visit Tim, who had been discharged from the army. The train ride was a nightmare, with Larry in a constant state of terror, shouting, “Kill me! Kill me!” Few onlookers understood his illness. In Tucson, Larry borrowed Tim’s coupe and went out driving alone, to return hours later, soaked with sweat. He had pushed the little car to eighty miles an hour, hoping it would skid off the road. It had not, and he had not let it.

Next, they went to the farming town in Ohio where Harriet’s large family lived. Larry was accepted with simple affection, but, soon tired of reading and of rides on his brother-in-law’s delivery truck, he began speaking wildly of suicide again. They pushed on to New Jersey, to live with another of Larry’s brothers. The East Orange psychiatrist took over again, gave Larry about thirty-five insulin and shock treatments, then refused to give any more. One night, Larry had convulsions and the doctor had to be summoned on the run. As analysis plodded on, without success, Harriet and Jack (who had just been discharged from A.T.C.), suggested hypnosis. The psychiatrist flatly rejected this. In desperation, the family confined Larry to the Veterans Hospital at Lyons, New Jersey. Larry was there several months, unable to keep his mind off himself, steadily growing worse.

In the end, it was neither Larry nor Jack, but a doctor at this Veterans Hospital, who brought up the subject of prefrontal lobotomy once more. The doctor sent a recommendation for lobotomy, along with Larry’s case history, to the Veterans Administration. The VA turned the recommendation down.

Meanwhile, another doctor, in the same hospital, made an off-the-record suggestion that the lobotomy be performed on the outside by private doctors. He recommended an experienced psychosurgery team in the East. For ethical reasons, I shall refer to this team under the fictional names of Drs. Leon Goldsmith and Raymond Rogers, and locate them in Boston. The army doctor thought that Goldsmith and Rogers were among the best, and least expensive, in the country, for the particular job at hand. In desperation, Jack and Harriet asked the opinions of seven different doctors on the advisability of lobotomy. Four were against it. Three were for it.

Who was to make the decision? Larry was too ill, too torn by pain, to care about anything. His wife, Harriet, was too upset and bewildered to decide. And so, the major weight of the decision devolved upon his brother. Inexperienced though he was. Jack weighed both sides of the matter carefully. Doctors, obviously, could not give him a clear-cut answer. Their opinions on lobotomy were split almost down the middle. But there was still one more thing to ask them. Without lobotomy, was there any hope for Larry’s recovery? The answer was unanimously no. A miracle might happen, of course, but they had no statistics supporting miracles. On the other hand, Larry might one day succeed in killing himself, although they held this unlikely. “He’ll soon go into a completely psychotic state,” they agreed, “and have to be institutionalized for the rest of his life.”

This promise of Larry’s future, combined with his relentless decline, suddenly panicked Jack. Lobotomy was useful only if a patient still had his grip on reality. Larry was rapidly losing his grip and might soon be beyond lobotomy. Time had become a factor. Jack could see no other choice. There appeared no less drastic treatment left. Lobotomy was relatively painless, even less uncomfortable than having one’s tonsils extracted, they said, and it was relatively safe, with a record of only a 3 percent fatality. Whatever else it might do to Larry, lobotomy would relieve him of anxiety. Larry was consulted. He was almost beyond coherence but agreeable to anything, even euthanasia. Harriet and the other Cassidy brothers were consulted, and reluctantly they all agreed that there was nothing else to do.

During the last week in March, 1947, Jack and Harriet journeyed to Boston to consult with Drs. Goldsmith and Rogers. Jack and Harriet waited in a reception room with seven or eight other people, mostly relatives of patients. However, there was one actual patient, a robust, middle-aged woman, who kept conversing with her husband, speaking, at the top of her voice. Since everyone else in the room was silent, her loudness made them stare. Once, she stared back at the others, then yelled, “Don’t worry, I’m fine! Look at me! I’m happy! I feel wonderful!” Jack glanced at Harriet, apprehensively. The woman’s husband caught the glance, and later, managed to sit down beside Jack. “She really is doing quite well, you know,” the husband explained. “Since her lobotomy, she’s taking an interest in housework again. She even does the dishes occasionally.”

Presently, Jack and Harriet were ushered in to meet Dr. Goldsmith, a serious, bespectacled, middle-aged man, gaunt and lanky. In preparing for the lobotomies, he was the psychiatrist of the team. He diagnosed the illness and plotted the operation. Dr. Rogers, a heavyset, easygoing lowan, was the surgeon.

When Jack finished his recital of Larry’s ills and previous treatments, he asked Dr. Goldsmith one question. “Will the operation do Larry any good?” Dr. Goldsmith reassured him that they were most successful in handling cases of Larry’s type, that is, anxiety cases. Dr. Goldsmith said that prefrontal lobotomy would definitely free Larry from his fears and anxiety, but he reminded Jack and Harriet that the operation might also make Larry lose his sense of responsibility, as well as his knowledge of social graces. For example, shortly after the operation, he might urinate while in the living room, instead of going to the bathroom. Also, he would lack initiative and have a confused sense of time. He would remember his nervous illness, but it would be a faraway thing. He would remember the lobotomy itself, but only when reminded, and only as something that seemed to have happened to someone else. Finally, he would never be able to do creative work, like writing, again. At best, he might succeed at holding a clerical position.